Florida Health Care Expenditures Report

Transcription

1 Florida Health Care Expenditures Report 2015

2 Table of Contents Table of Contents... i Florida Health Care Expenditures in Introduction... 1 Data and Methodology... 1 Findings... 2 Overall Trend... 2 Expenditures by Payer... 9 Florida HMO Expenditures Tables Appendices Citations Table of Figures Figure 1: Florida Expenditures Annual Percentage Change and Total Expenditures, Figure 2: Health Service Expenditures, percent change from previous year... 4 Figure 3: Expenditures by Health Service in 2015, Percent of Total Expenditures in 2015 comparing Florida and the U.S Figure 4: Florida Expenditures by Health Service in 2011 and 2015, percent change of total expenditures Figure 5: Expenditures by Health Service Percentage Change, Figure 6: Health Service Categories, Hospital Care, Physician & Clinical services, and Prescription Drugs & Non-durable medical products, annual percentage change in Florida Figure 7: Florida Expenditures by Health Care Payer, Figure 8: Expenditures by Payer in Florida and the U.S., percent of total expenditures Figure 9: Expenditures by Payer in Florida, comparing 2011 and Figure 10: Medicaid and Medicare expenditures per recipient and annual percentage change in expenditures, Florida Health Care Expenditures 2015 Page i of 34

3 Figure 11: Total HMO expenditures in Florida and percent change in expenditures, Figure 12: Proportion of total expenditures by HMO lines of businesses, Figure 13: Total enrollment and premiums/enrollment percent change, Table of Tables Table 1: Health Care Service expenditures (in billions), Florida and U.S., Table 2: Health Care Service expenditures annual percent change in Florida and U.S., Table 3: Health Care Service categories percent of total expenditures, Florida and U.S., Table 4: Health Care Payer expenditures, (in billions), Florida and U.S., Table 5: Health Care Payer expenditures annual percent change, Florida and U.S., Table 6: Population and age data in Florida and the U.S., Table 7: Health Care Payer expenditures percent of total expenditures, Florida and U.S., Table 8: HMO Premiums and enrollment information for Florida and U.S., Appendices Appendix A: Match of SIC to NAICS Categories Used For Some of the Florida Healthcare Service Expenditures Appendix B: Match of NAICS Categories Used For Some of the Florida Healthcare Services Expenditures for the 2014 Report Appendix C: Healthcare Service Categories, Data Source and Definitions for Florida Appendix D: Healthcare Payer Categories, Data Source and Definitions Appendix E: HMO s Expenditures Categories, Data Source and Definitions Appendix F: HMO s Premium Categories, Data Source and Definitions Appendix G: HMO s enrollment categories data source and definitions Florida Health Care Expenditures 2015 Page ii of 34

4 Florida Health Care Expenditures in 2015 Introduction The Florida Agency for Health Care Administration (Agency) has published the Florida Health Care Expenditures Report annually since This statistical brief updates the Expenditures Report, displaying trends in Florida health care expenditures during calendar year Health care expenditures equal a combination of revenues and wages from health care providers, such as facilities and practitioners, who provide services and medical supplies to individual patients. Wage data is obtained from the Florida Department of Economic Opportunity (DEO). The revenue from these providers is obtained by various sources including consumers, insurers, and government agencies. This statistical brief specifically provides expenditure information relating to health care services, health care payers, and health maintenance organizations (HMOs). Data and Methodology DEO wage data for Florida is grouped according to the North American Industry Classification System (NAICS) i. NAICS is a national standard used to group business organizations in specific categories for collecting, analyzing, and publishing statistical data ii. Prior to 2002, the Expenditures Report used the U.S. Standard Industrial Classification (SIC) Manual iii as the standard grouping method for the expenditures. To maintain consistency with the reports over the years, the expenditures grouped by NAICS were matched up to the SIC groupings, creating the categories used in the reports between 2002 and The mapping was done by using the SIC 2012 NAICS Crosswalk (see Appendix A). This report has updated the NAICS groupings to reflect the current National Health Expenditures (NHE) categories with the new crosswalk provided in Appendix B, provided by the Centers for Medicare and Medicaid Services (CMS), and the most recent census year data iv. The dashboard for this year s report showcases the prior year s methodologies and groupings to show the trends from 1992 to 2015 as well as the new methodology and groupings. The new methodology as applied in this written report will be used going forward, showing the data from 2011 onward. There is not an exact match from the NAICS and SIC categories, creating some discrepancy in the data from prior years reports when comparing the individual expenditure categories between Florida and the U.S. Wages constitute 36 percent of total health care expenditures. DEO wage data and the most recent wage and expenditure data provided by the U.S. Census Bureau were used to calculate Florida expenditures for most of the health care service categories. To identify health expenditures other than wages, which DEO does not provide, a ratio was developed using the DEO wage data and the most recent U.S. Census year wage and population data (2007). This ratio was then applied to the National Health Expenditures to create Florida specific estimates. These categories included Medicinal Drugs and Durable Medical Equipment v,vi. The NHE data is updated and revised every year for the current and previous periods, resulting in expenditures displayed in this statistical brief being different from figures in previous years reports. The Expenditures Report includes services provided for both residents and non-residents in the state of Florida. Florida Health Care Expenditures 2015 Page 1 of 34

5 The principal health care payer categories include Medicaid, Medicare, other public funds, private insurance, out-of-pocket, and other private sources. The Division of Medicaid Finance & Analytics at the Agency provided the Medicaid payer expenditures. The 2015 Florida Medicare payer expenditures were estimated using the 2004 national and Florida Medicare expenditure ratio, along with the 2015 Medicare payer expenditures. The Medicaid and estimated Medicare expenditures, the estimated Florida health care service expenditures as described above, and the NHE obtained from CMS, were all used to create a ratio to estimate the other health care payer categories 2015 expenditures. The new methodology and categories used for the health care services were used for the ratio to estimate the health care payer categories. Enrollment information for Medicare was obtained from the one-year Census estimate vii. For Medicaid, the annual enrollment information was collected from the Office of Economic & Demographic Research Social Services estimating conference viii. Both of these enrollment figures were used to determine expenditure per enrollee information. The Florida Office of Insurance Regulation (FLOIR), Department of Financial Services, provided expenditure data on HMOs. These HMO plans include commercial, Medicare, and Medicaid lines of businesses. Individual HMO financial data was used to calculate the expenditures for HMO plans as well as the cost of premiums per enrollee, total premiums, and enrollment data. Findings Overall Trend In 2015, total health care expenditures in Florida reached $173.7 billion, up from $161.7 billion in In 2015, Florida had a 1.2 percent annual percent increase in expenditures compared to the U.S. total health service expenditures estimated percent increase of 0.8 percent. This was the second year Florida service expenditures increased at a higher rate than the U.S. expenditures. Health Care services spending per capita in the state of Florida reached $9,364 in 2015, or percent of personal income compared to percent of personal income in the U.S ix. Florida Health Care Expenditures 2015 Page 2 of 34

6 FIGURE 1: FLORIDA EXPENDITURES ANNUAL PERCENTAGE CHANGE AND TOTAL EXPENDITURES, Expenditures by Health Service Health care service expenditures categories include Hospital Care, Physician & Clinical Services, Other Professional Services, Dental Services, Other Health, Residential, and Personal Care, Home Health Care Services, Nursing Care Facilities, Prescription Drugs & Non-durable Medical Products, and Durable Florida Health Care Expenditures 2015 Page 3 of 34

7 Medical Equipment (see Appendix C). Data for the health care service graphs are displayed at the end of the findings in Tables 1, 2, and 3. Expenditures by Health Service, Percent of Total Expenditure. Figure 2 displays the proportion of total expenditures among the various health services provided in Florida in Hospital Care, Physician and Clinical Services, and Prescription Drugs & Non-durable Medical products accounted for 79 percent, or $138 billion, of Florida s total health care service expenditures. From , all service categories slightly increased their proportion of total service expenditures with Other Health, Residential, and Personal Care having the greatest proportional increase in Florida in The U.S. categories which showed slight decreases in their proportions of service expenditures from include Hospital Care Services, Durable Medical Equipment, Nursing & Continuing Care Facilities, and Dental Services. Prescription Drugs & Non-durable Medical products had the greatest proportional increase for the National Health expenditures. To see a dynamic view of Figure 2 please click here. FIGURE 2: HEALTH SERVICE EXPENDITURES, PERCENT CHANGE FROM PREVIOUS YEAR. Florida Health Care Expenditures 2015 Page 4 of 34

8 Expenditures by Health Service in 2015, percent of total expenditure in 2015 comparing Florida and in U.S. Figure 3 displays the comparison between the proportions of expenditures of the health services in Florida and the U.S. The top three health service categories with the largest expenditure proportions to the total were the same in Florida as the U.S., (Hospital Care, Physician & Clinical Services, and Prescription Drugs & Non-durable Medical products). From , the Prescription Drugs & Non-durable Medical products category showed the slight increase in the U.S. As for Florida there was a slight decrease in the Prescription Drugs & Non-durable Medical products category. Both Florida and the U.S. Prescription Drugs & Non-durable Medical products category remains as the third largest proportion of all the service expenditures. For both Florida and the U.S. service expenditures, the Hospital Service category remains the largest service expenditure category. Florida s hospital care service expenditures show a smaller proportion of total service expenditures at only 34.2 percent of the total compared to 38.1 percent of the total service expenditures for the U.S. For the second largest category, Physician & Clinical services, the proportional difference between Florida and the U.S. was 6 percent with Florida showing 29.4 percent of the total and the U.S. having 23.4 percent of the total service expenditures. Florida also had a larger proportion of Prescription Drugs & Non-durable Medical products at 15.6 percent of the total service expenditures compared to the U.S. Prescription Drugs & Non-durable Medical products proportion to the total. Florida Health Care Expenditures 2015 Page 5 of 34

9 To see a dynamic view relating to Figure 3 please click here. FIGURE 3: EXPENDITURES BY HEALTH SERVICE IN 2015, PERCENT OF TOTAL EXPENDITURES IN 2015 COMPARING FLORIDA AND THE U.S. Other Health Services All Other Health Services Other Health Services Florida Expenditures by Health Service in 2011 and 2015, percent change of total expenditure. Figure 4 displays the individual Health Service categories expenditures totals and their percent change from the beginning of use of the new methodology in The length of the bars is the amount of expenditures for that service in billions. Florida Health Care Expenditures 2015 Page 6 of 34

10 The Other Health, Residential, and Personal Care service category showed the largest percent change increase from 2011 at percent and has the smallest proportion of the total expenditures. Nursing & Continuing Care Facilities had the smallest percent change from 2011 at 7.98 percent. Hospital Care Services is the largest proportion to the total service expenditures, but had the second smallest percent change from 2011 to To see a dynamic view of graphs relating to Figure 4 please click here. FIGURE 4: FLORIDA EXPENDITURES BY HEALTH SERVICE IN 2011 AND 2015, PERCENT CHANGE OF TOTAL EXPENDITURES. Expenditures by Health Service percent change, Figure 5 displays the service category percentage changes in expenditures from 2014 to 2015 for Florida. In both Florida and the U.S., Prescription Drugs & Non-durable Medical Products have decreased from over 10 percent in 2014 to 8 percent in Florida Health Care Expenditures 2015 Page 7 of 34

11 The Durable Medical Equipment category percentage change from 2014 to 2015 in both Florida and U.S. displays a 3.94 percent change. That is a 5 percent decrease for Florida from 2013 to The top cost driver for expenditures, Hospital Care Services, had one of the largest annual percent increases in Florida in 2015 at only 8.43 percent compared to 2014 at 4.24 percent. To see a dynamic view relating to Figure 5 please click here. FIGURE 5: EXPENDITURES BY HEALTH SERVICE PERCENT CHANGE, Health Service categories, Hospital Care, Physician & Clinical Services, and Prescription Drugs & Nondurable Medical Products, annual percentage in Florida, Figure 6 displays the annual percent changes from 2012 through 2015 for the top three service expenditure cost drivers in Florida. Of the top three cost drivers, Hospital Care Services showed the largest percent change in Prescription Drugs & Non-durable Medical Products in had high percent change of about 9 percent, and in it deceased by 3 percent. Physician and Clinical Services slightly decreased in Florida Health Care Expenditures 2015 Page 8 of 34

12 FIGURE 6: HEALTH SERVICE CATEGORIES, HOSPITAL CARE, PHYSICIAN & CLINICAL SERVICES, AND PRESCRIPTION DRUGS & NON-DURABLE MEDICAL PRODUCTS, ANNUAL PERCENTAGE CHANGE IN FLORIDA Expenditures by Payer Health care payer expenditures are separated into six principal categories, Medicare; Medicaid; Other Private Sources; Other Public Funds; Out-of-Pocket; and Private Insurance (see Appendix D). Detailed data for health care payer graphs are displayed at the end of the findings in Tables 4 and 5. Florida Expenditures by Health Care Payer, Figure 7 displays Private Insurance and Medicare were the two largest payer expenditure categories in Florida. From Medicaid remained steady as the third largest over the 4-year period, with Out-of-Pocket payers being a close fourth. The two smallest payer categories, Other Public Funds and Other Private Sources, have remained the smallest payer expenditure categories from Even though Other Public Funds has remained one of the smaller payer categories, the 2015 expenditures increased by 1.3 billion in Florida and 11.6 billion in the U.S. Out-of-Pocket expenses had Florida Health Care Expenditures 2015 Page 9 of 34

13 the lowest expenditure percent of increase in Florida compared to any other category at 4.29 percent. To see a dynamic view relating to Figure 7, please click here. FIGURE 7: FLORIDA EXPENDITURES BY HEALTH CARE PAYER, Florida Health Care Expenditures 2015 Page 10 of 34

14 Expenditures by Payer in Florida and the U.S., Percent of total expenditures. Figure 8 displays the proportion of health care payer categories expenditures to the total, displaying both Florida and U.S. For both Florida and the U.S., Private insurance remains the largest payer expenditure category. The Medicare payer category displayed the largest percentage difference between Florida and the U.S., representing a larger proportion of Florida s payer expenditures by over 4 percent. In 2015, Florida s over 65 population was over 5 percent greater than the national average, likely contributing to larger Medicare expenditures. Offsetting the larger Medicare proportion, the Florida Medicaid payer category represented a smaller portion of health care payers than the national Medicaid payer proportions by over 10 percent. Medicare, Medicaid, and Other Public Funds expenditures sligthly incresed their proportions of total payer expenditures in 2015 compared to 2014 in Florida. In the U.S., all payer categories showed a proportional increase from Florida Health Care Expenditures 2015 Page 11 of 34

15 To see a dynamic view relating to Figure 8 please click here. FIGURE 8: EXPENDITURES BY PAYER IN FLORIDA AND THE U.S., PERCENT OF TOTAL EXPENDITURES. Florida Health Care Expenditures 2015 Page 12 of 34

16 Expenditures by Payer in Florida, comparing 2011 and Figure 9 displays the individual health payer categories expenditures totals and their percent change from the beginning of the use of the new methodology in Other private sources, private insurance, and other public funds were the payer categories, which displayed the increase percent change of over 20 percent in Florida in 2015 compared to Other Private Sources had a 29 percent increase from , yet represents the smallest proportion of total expenditures. Out-of-Pocket payer expenditures had the smallest percent change increase of 14 percent, comparing 2011 to To see a dynamic view relating to Figure 9 please click here FIGURE 9: EXPENDITURES BY PAYER IN FLORIDA, COMPARING 2011 AND Medicaid and Medicare Expenditures per Recipient and Annual Percentage change in Expenditures, Figure 10 shows Medicaid payers showed a 3.4 percent decrease in expenditures in 2015, coinciding with a 2.23 percent decrease in spending per recipient. Medicare showed a decrease in expenditures as well as in spending per recipient. Florida Health Care Expenditures 2015 Page 13 of 34

17 Medicare expenditures per enrollee decreased after increasing in 2014, with the 2015 expenditures/enrollee increase change being 0.8 percent. In 2015 the caseload for Medicare decreased by 3.6 percent, which is 0.1 percent lower than in Medicare enrollment included the total of both original Medicare and Medicare Advantage plans. FIGURE 10: MEDICAID AND MEDICARE EXPENDITURES PER RECIPIENT AND ANNUAL PERCENTAGE CHANGE IN EXPENDITURES, Florida Health Care Expenditures 2015 Page 14 of 34

18 Florida HMO Expenditures HMO expenditures encompass Medicaid, Medicare, and commercial lines of businesses. The HMO plans in Florida are regulated by the FLOIR, and the financial statements were obtained from the annual financial statements collected by the Florida Department of Financial Services (see Appendices E, F, and G). Data coinciding with many of these HMO graphs are displayed at the end of the findings in Tables 6, 7, and 8. Total HMO Expenditures in Florida and Percent change in Expenditures, Figure 11 shows in 2015, Florida HMO expenditures increased from 2014 by percent, to a total of $33.70 billion. This is the fourth year in a row in which HMO expenditures have displayed an increased growth rate. This is also the largest growth rate reported since Florida Health Care Expenditures 2015 Page 15 of 34

19 To see a dynamic view relating to Figure 11 click here FIGURE 11: TOTAL HMO EXPENDITURES IN FLORIDA AND PERCENT CHANGE IN EXPENDITURES, Florida Health Care Expenditures 2015 Page 16 of 34

20 Proportion of Total Premiums by HMO Line of Businesses, In 2015, the largest proportion of the HMO revenue source came from Medicare at percent, coinciding with Medicaid being the second largest payer category. This is a decrease in percent of total for Medicare premiums from Medicare premiums comprise $15 billion of the over $37 billion in total premiums. Medicare had the largest premiums percent change decrease. Figure 12, indicates a decrease in proportion to the total enrollment for Medicare, but an increase in proportion for Medicaid and slight decrease Commercial in Overall, the HMO premium revenue increased by percent in 2015, coinciding with a percent HMO enrollment annual change. FIGURE 12: PROPORTION OF TOTAL PREMIUMS BY HMO LINES OF BUSINESSES, Florida Health Care Expenditures 2015 Page 17 of 34

21 Total Enrollment and Premiums/Enrollment Percent change, Figure 13 shows the HMO annual enrollment and premiums per enrollee percent change for Commercial, Medicaid and Medicare line of businesses trends from 2012 through The premium per enrollee percent change highlights whether the premium amounts increased or decreased. In 2015, HMO commercial plans reported an annual increase in the premium change percentage of 2 percent in Commercial plans represent the largest proportions of the total enrollment at 40 percent and a 23 percent increase in enrollment from The premiums per enrollee deceased by 2 percent in Medicaid HMO enrollment has continued to rise for the third year in a row reaching 2.68 million in Similar to the commercial plans, the premiums per enrollee for Medicaid HMO s have also decreased in 2015 by 6 percent. Medicaid plans represent the largest proportions of the total enrollment at 45 percent increase in enrollment in Medicare is the only line of business that showed an increase in premiums per enrollee percentage at 31 percent, with enrollment decreasing. This is the first time in years for a high percent increase in premiums per enrollee for Medicare line of businesses. Florida Health Care Expenditures 2015 Page 18 of 34

22 To see a dynamic view relating to Figure 13 please click here. FIGURE 13: TOTAL ENROLLMENT AND PREMIUMS/ENROLLMENT PERCENT CHANGE, Florida Health Care Expenditures 2015 Page 19 of 34

23 Tables Table 1: Health Care Service expenditures (in billions), Florida and U.S., Table 2: Health Care Service expenditures annual percent change in Florida and U.S., Florida Health Care Expenditures 2015 Page 20 of 34

24 Table 3: Health Care Service categories percent of total expenditures, Florida and U.S., Table 4: Health Care Payer expenditures, (in billions), Florida and U.S., Florida Health Care Expenditures 2015 Page 21 of 34

25 Table 5: Health Care Payer expenditures annual percent change, Florida and U.S., Table 6: Population and age data in Florida and the U.S., Florida Health Care Expenditures 2015 Page 22 of 34

26 Table 7: Health Care Payer expenditures percent of total expenditures, Florida and U.S., Table 8: HMO Premiums and enrollment information for Florida and U.S., Florida Health Care Expenditures 2015 Page 23 of 34

27 Appendices Appendix A: Match of SIC to NAICS Categories Used For Some of the Florida Healthcare Service Expenditures. The old methodology used in AHCA reports from are shown in the methodology of the dashboard. Methodology, prior to 2014 Florida Expenditure Report Category Physicians (MD) 8011 Physicians (MD) 8011 Physicians (MD) 8011 Physicians (MD) 8011 Dentists 8021 Other Health Professionals 8041 Other Health Professionals 8042 Other Health Professionals 8049 Other Health Professionals 8049 Other Health Professionals 8043 Other Health Professionals 8049 Nursing Care Facilities Nursing Care Facilities Nursing Care Facilities SIC ID SIC Description NAICS ID NAICS description 8051/ / / 8052 Hospitals 8062 Offices and Clinics of Medical Doctors Offices and Clinics of Medical Doctors Offices and Clinics of Medical Doctors Offices and Clinics of Medical Doctors Offices and Clinics of Dentists Offices and Clinics of Optometrists Offices and Clinics of Optometrists Offices of Health Practitioner Offices of Health Practitioner Offices and Clinics of podiatrists Offices and Clinics of podiatrists Skilled Nursing Facilities/ Intermediate Care Facilities Skilled Nursing Facilities/ Intermediate Care Facilities Skilled Nursing Facilities/ Intermediate Care Facilities General Medical and Surgical Hospitals Offices of Physicians (except Mental Health Specialists) Offices of Physicians, Mental Health Specialists HMO Medical Centers Freestanding Ambulatory Surgical and Emergency Centers Offices of Dentists Offices of Chiropractors Offices of Optometrists Offices of Mental Health Practitioners (except physicians) Offices of specialty therapists Offices of podiatrists Hospitals 8063 Psychiatric Hospitals Offices of miscellaneous health practitioners Nursing care facilities, skilled nursing Residential developmental disability homes Continuing care retirement communities General medical and surgical hospitals Psychiatric and substance abuse hospitals Florida Health Care Expenditures 2015 Page 24 of 34

28 Hospitals 8069 Specialty Hospitals, Except Psychiatric Other hospitals Medical Labs 8071 Medical Laboratories Medical Laboratories Medical Labs 8071 Medical Laboratories Diagnostic imaging centers Medical Labs 8072 Dental Laboratories Dental laboratories Home Health Care Services 8082 Home Health Care Services Home health care services Miscellaneous Health Services 8093 Specialty Outpatient Clinics Family planning centers Miscellaneous Health Outpatient mental health 8093 Specialty Outpatient Clinics Services centers Miscellaneous Health Services 8092 Kidney Dialysis Centers Kidney dialysis centers Miscellaneous Health All other outpatient care 8093 Specialty Outpatient Clinics Services centers Miscellaneous Health Services 8099 Health and Allied Services Blood and organ banks Miscellaneous Health Miscellaneous ambulatory 8099 Health and Allied Services Services health care services Florida Health Care Expenditures 2015 Page 25 of 34

29 Appendix B: Match of NAICS Categories Used For Some of the Florida Healthcare Services Expenditures for the 2015 Report. The new methodology is used in the dashboard. NAICS Industry Title 2015 Florida Expenditure Report Category ID Physician and Clinical Services Offices of physicians, except mental health Physician and Clinical Services Offices of mental health physicians Physician and Clinical Services Family planning centers Physician and Clinical Services Outpatient mental health centers Physician and Clinical Services HMO medical centers Physician and Clinical Services Kidney dialysis centers Physician and Clinical Services Freestanding emergency medical centers Physician and Clinical Services All other outpatient care centers Physician and Clinical Services Medical laboratories Physician and Clinical Services Diagnostic imaging centers Hospital Care General medical and surgical hospitals Hospital Care Psychiatric and substance abuse hospitals Hospital Care Other hospitals Other Professional Services Offices of chiropractors Other Professional Services Offices of optometrists Other Professional Services Offices of mental health practitioners Other Professional Services Offices of specialty therapists Other Professional Services Offices of podiatrists Other Professional Services Offices of miscellaneous health practitioners Dental Services Offices of dentists Other Health, Residential, and Personal Care Ambulance services Other Health, Residential, and Personal Care Residential developmental disability homes Other Health, Residential, and Personal Care Residential mental and substance abuse care Home Health Care Services Home health care services Nursing Care Facilities and continuing care retirement communities Nursing Care Facilities and continuing care retirement communities Nursing care facilities, skilled nursing Continuing care retirement communities Florida Health Care Expenditures 2015 Page 26 of 34

30 Appendix C: Healthcare Service Categories, Data Source and Definitions for Florida. Service Data Source Definitions Total Health Care Service Expenditures 2012 Economic 5-YEAR Census of the U.S. and the Department of Economic Opportunity. The year census data for some of the retail sales categories. The Health Service Categories used are from the North American Industry Classification System (NAICS). The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for each of the health service categories. For categories where wage data was not appropriate, the National Health care Expenditures from CMS were obtained and used with Census data on optical goods, population, and drugstores expenditures as a ratio. Dental Services Durable Medical Equipment Home Health Care Services Hospital Care Nursing and Personal Care Facilities 2012 Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories National Health Care Expenditures from the Centers for Medicare & Medicaid Services, and the year data Optical Goods sales NAICS category Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The NAICS categories include Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories , , and Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories and The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, , Offices of Dentists. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for the health service category, Dental. Covers retail sales of items such as contact lenses, eyeglasses and other ophthalmic products, surgical and orthopedic products, hearing aids, wheelchairs, and medical equipment rentals The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, , Home Health Care Centers. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest 2014, for the health service category, Home Health Care Services. The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, general medical and surgical hospitals, psychiatric and substance abuse hospitals, and other hospitals. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for the health service category, Hospital Care. The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, Nursing care facilities, skilled nursing, Continuing care retirement communities. This is then multiplied by the ratio of the annual wages Florida Health Care Expenditures 2015 Page 27 of 34

31 reported in 2012 to the year of interest, 2014, for the health service category, Nursing care facilities. Other Professional Services Other Health, Residential, and Personal Care Physician and Clinical Services Prescription Drugs + Nondurable Medical Products 2012 Economic 5-year census data, the U.S., and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories , , , , , Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories , , and Economic 5-year census data and the U.S. and the Department of Economic Opportunity 2015 Florida wage data. The categories includes the NAICS categories , , , , , , , , and National Health Care Expenditures from the Centers for Medicare & Medicaid Services, and the year data Pharmacy sales NAICS category The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, Offices of chiropractors, optometrists, mental health practitioners, specialty therapists, podiatrists, and miscellaneous health practitioners. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for the health service category, Other professional services. The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity Includes spending for Medicaid home and community based waivers, care provided in residential care facilities, ambulance services, school health and worksite health care. These programs provide payments for services in non-traditional settings such as community centers, senior citizens centers, schools, and military field stations. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for the health service category, Other Health, residential and personal care. The 2012 Total Receipts/Wages reported by the 2012 U.S. Census, multiplied by the 2012 annual wages reported by the Department of Economic Opportunity for NAICS category, offices of physicians, offices of mental health physicians, family planning centers, HMO medical centers, kidney dialysis centers, medical laboratories, diagnostic imaging centers, and freestanding emergency medical centers. This is then multiplied by the ratio of the annual wages reported in 2012 to the year of interest for the health service category, Hospital Care. Includes the sales of human-use dosage-form drugs, biological drugs, and diagnostic products that are available only by a prescription. Also includes the retail sales of non-prescription drugs and medical sundries Florida Health Care Expenditures 2015 Page 28 of 34

32 Appendix D: Healthcare Payer Categories, Data Source and Definitions Payer Data Source Definition Health Care Payer Expenditures 2014 National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount. Includes Expenditures Payer categories using the National Healthcare Expenditures (NHE) and the calculated service expenditures. A ratio is created using the NHE and the National services expenditures to determine the Payer expenditures in Florida. It is then adjusted using the actual Medicaid expenditure data while also taking into consideration the Medicaid Crossover Adjustment. Medicaid Medicare Other private Sources Other Public Funds 2014 National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, Includes expenditures from Medicaid payers Includes expenditures from Medicare payers Includes expenditures from Other Private Revenues payers Includes expenditures from Department of Defense, Department of Veterans Affairs, Worksite Health Care, Indian Health Services, Workers' Compensation, General Assistance, Maternal/Child Health, Vocational Rehabilitation, Other Federal programs, SAMHSA, Other State & Local Programs, and School Health payers. Florida Health Care Expenditures 2015 Page 29 of 34

33 Out-of- Pocket Private Insurance and adjusted for the Medicaid Crossover amount National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount National Health Care Expenditures from the Centers for Medicare & Medicaid Services, The 2015 calculated Service expenditures, Actual Medicaid spending from AHCA's Medicaid Program Finance Unit, and adjusted for the Medicaid Crossover amount. Includes expenditures from Out-of-Pocket payers Includes expenditures from Private Health Insurance payers. Florida Health Care Expenditures 2015 Page 30 of 34

34 Appendix E: HMO s Expenditures Categories, Data Source and Definitions. HMO Expenditure Categories HMO Expenditures Outside Referrals Other Professional Services Hospital/Medical Benefits/Prescription Drugs Emergency Room and Outof-Area Aggregate Write- Ins/Incentive Pool, withhold adjustments and bonus amounts/net Reinsurance Recoveries Source Department of Financial Services; Health Plans Statement of Revenue and Expenses Department of Financial Services; Health Plans Statement of Revenue and Expenses Department of Financial Services; Health Plans Statement of Revenue and Expenses Department of Financial Services; Health Plans Statement of Revenue and Expenses Department of Financial Services; Health Plans Statement of Revenue and Expenses Department of Financial Services; Health Plans Statement of Revenue and Expenses Definition Total revenue from Florida HMO health plans Total revenue from Florida HMO health plans from outside referrals Total revenue from Florida HMO health plans from other professional services Total revenue from Florida HMO health plans from a combined total of hospitals, medical benefits, and prescription drugs Total revenue from Florida HMO health plans from emergency rooms, and out-of-area services Total revenue from Florida HMO health plans from Aggregate Writeins/Incentive Pool, withhold adjustments and bonus amounts/net reinsurance recoveries Florida Health Care Expenditures 2015 Page 31 of 34

35 Appendix F: HMO s Premium Categories, Data Source and Definitions. HMO Premium Categories HMO Premiums Commercial Medicaid Medicare Source Department of Financial Services; Health Plans Statement of Revenue and Expenses Florida Office of Insurance Regulation Florida Office of Insurance Regulation Florida Office of Insurance Regulation Definition Premiums and Other Considerations by Carrier by Market Segment (Accident/Health, Medicaid, and Medicare) Premiums and Other Considerations by Carrier by Market Segment (Accident/Health) Premiums and Other Considerations by Carrier by Market Segment (Medicaid) Premiums and Other Considerations by Carrier by Market Segment (Medicare) Florida Health Care Expenditures 2015 Page 32 of 34

36 Appendix G: HMO s enrollment categories data source and definitions. HMO Enrollment Categories HMO Enrollment Commercial Medicaid Medicare Source Florida Office of Insurance Regulation Florida Office of Insurance Regulation Florida Office of Insurance Regulation Florida Office of Insurance Regulation Definition Enrollment by Carrier Average of the 4 quarters of the yearly data Enrollment by Carrier (Small Group, Large Group, Individual, Healthy Kids, Conversion, and Other), Average of the 4 quarters of yearly data Enrollment by Carrier (Medicaid) Average of the 4 quarters of the yearly data Enrollment by Carrier (Medicare) Average of the 4 quarters of the yearly data It should be noted the national health expenditures obtained by CMS, do not include a separate category for Medical Laboratories; therefore, the estimates of the individual categories are slightly different when comparing to Florida estimates. Florida Health Care Expenditures 2015 Page 33 of 34

37 Citations i Labor Market Statistics Center. (2014). Annual Employment and Wages, Florida Department of Economic Opportunity. (Annual ES-202). ii U.S. Census Bureau. (2002). North American Industry Classification System-United States, (NTIS No. PB ). iii iv Centers for Medicare and Medicaid Services. (December 2016). National Health Expenditures by type of service and source of funds, CY v U.S. Census Bureau (December 2016) Economic Census Retail Trade--Florida. vi U.S. Census Bureau (December 2016) Economic Census Retail Trade United States. vii U.S. Census Bureau (December 2016) American Community Survey 1-Year Estimates. viii Social Services Estimating Conference Medicaid Caseload and Expenditures. (2016). Medicaid Caseload Summary. Office of Economic & Demographic Research. ix U.S. Department of Commerce; Bureau of Economic Analysis; Regional Economic Information System. (December 2016). State Personal Income. Florida Health Care Expenditures 2015 Page 34 of 34

38 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL Produced by AHCA Multimedia DesigN